There are many different types of conjunctivitis and most are self-limiting.
Bacterial conjunctivitis has thick green/yellow discharge. The eye can be stuck together in the morning but there is also usually discharge noticed throughout the day.
Other family members/friends may be affected. Ensuring good hand hygiene is recommended to prevent spread.
It can be difficult to tell the difference between bacterial and viral conjunctivitis. Patients with viral conjunctivitis tend to have a current or recent viral illness. The discharge is thinner and can be watery. Often follicles/papillae can be seen under the lids with viral conjunctivitis.
Some cases of viral conjunctivitis can be prolonged and require further treatment especially if involving the cornea and not resolving within 7 days as expected. Swabs are not sent routinely but if conjunctivitis is not improving as expected consider sending swabs (for eye viruses, bacteria and chlamydia/gonorrhoea) and referring to ophthalmology.
Allergic conjunctivitis is common especially around the summer months. Eyelids can also have follicles and papillae noted on eversion. This can be seen with a hand held ophthalmoscope under high magnification. The characteristic sign of allergy is itch. Management is in the community in conjunction with optometrists. Typical treatments include sodium cromoglicate/olopatadine eye drops and antihistamines. In those where there is co-existing eczema topical hydrocortisone to the lids only may be of benefit.
Conjunctivitis in babies <4 weeks old should be referred for assessment due to the possibility of sexually transmitted infection. There is typically purulent discharge and a red eye. It can be bilateral and babies can be unwell. Swabs should be sent for chlamydia and gonorrhoea.
Sticky eyes are common in babies due to their small nasolacrimal ducts and lid massage can help alleviate symptoms. They do not have discharge or a red eye and it tends to be unilateral.
Who to refer:
Please see Lothian GP and optometry ophthalmology referral pathway.
Urgency of the condition for details on how soon patients should receive an appointment.
Patients who present with a problem with their only seeing eye should be advised to see an optician/ophthalmologist for review.
How to refer:
We require a referral letter for EVERY patient.
The preferred referral process is via SCI Gateway. If sending/forwarding a referral via SCI gateway please include past medical history, allergies and medications
If you do not have access to fax or SCI Gateway e.g. if you have arranged an appointment out of hours please send a written referral letter with the patient to bring to their appointment.
Only if SCI Gateway is unavailable should a letter be typed or handwritten. Please write legibly and include your examination findings.
If you have arranged an appointment in the acute referral clinic and you are referring from within another hospital in Lothian please use TRAK to type the referral letter.
